The Los Angeles VA hospital, the largest veterans hospital in the nation, treats 80,000 veterans annually. The L.A. system includes the hospital, nursing homes, a domiciliary, three outpatient care sites and 10 community clinics.

Last year, the hospital closed its psychiatric emergency department and now treats veterans with mental health emergencies in the main ED, the Times reports. Since the shift, critics say there have been several occurrences where psychiatric patients were sent to inpatient wards without written orders or treated by ED nurses who were unsympathetic to their conditions.

Rep. Henry Waxman (D-Calif.), whose district includes the VA facility, said he disagrees with closing the psychiatric emergency department. He said, "I'm disappointed that the VA has not responded more aggressively. With Iraq and Afghanistan war veterans returning, these demands are only going to increase."

Ten years ago, the L.A. VA hospital had the ability to treat 450 veterans with mental illnesses daily, but after funding reductions and facility consolidations, the main VA facility in Los Angeles now is able to accommodate only 90 veterans overnight in its psychiatric department.

Over the same 10-year period, the number of veterans with mental illnesses who were treated by VA hospitals in Los Angeles increased by about 28%, the Times reports.

VA Response

Dean Norman, chief of staff for the Los Angeles veterans' hospital, said the closure of the psychiatric emergency department was justified by the decrease in patients. Norman said, "One of our goals is to be good stewards of taxpayer dollars. We didn't make this in a precipitous or reckless fashion. This was well thought out, and we had good reasons for doing this."

Los Angeles VA officials say they offer a wider variety of mental health services, mostly in the form of outpatient programs. The hospital uses outpatient programs and partners with not-for-profit organizations to provide temporary accommodations for veterans, according to officials (Ornstein, Los Angeles Times, 3/21).

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